發(fā)布時(shí)間：2018-06-10 02:46

  本文選題：冠狀動脈疾病 + 替格瑞洛��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:抗血小板治療是冠心病治療的基石,目前抗血小板治療的重要藥物之一就是氯吡格雷。研究發(fā)現(xiàn)4%～31%的患者存在氯吡格雷抵抗,氯吡格雷抵抗的原因眾多,已經(jīng)證實(shí)氯吡格雷抵抗與體內(nèi)氯吡格雷代謝基因的多態(tài)性相關(guān)[1],因此美國食品藥品監(jiān)督管理局(U.S.Food and Drug Administration,FDA)建議醫(yī)生對需要該類藥物行抗血小板治療前通過檢測CYP2C19基因型以了解患者氯吡格雷的代謝能力,對于氯吡格雷代謝弱者可選擇其他抗血小板藥物,如替格瑞洛、普拉格雷。鑒于目前普拉格雷在我國尚未正式上市,而替格瑞洛并未納入醫(yī)療保險(xiǎn)且費(fèi)用相對昂貴,臨床實(shí)際工作中仍以氯吡格雷坐為首選的P2Y12受體抑制藥。對于氯吡格雷基因檢測提示慢代謝的患者建議改用替格瑞洛已經(jīng)形成了廣泛的共識,但是對于中代謝患者是否換用替格瑞洛尚值得探討。本研究探討替格瑞洛對氯吡格雷中間代謝類型冠心病患者PCI術(shù)后的影響。方法:研究選取2015年12月至2016年9月于大連醫(yī)科大學(xué)附屬第一醫(yī)院心內(nèi)科收治的冠心病并接受治療的患者97例。對入院后診斷為冠心病并行PCI治療的全部患者,常規(guī)給予阿司匹林(300m/l OOmg qd)、氯吡格雷(300mg/75mg qd)常規(guī)雙聯(lián)抗血小板藥物治療1,并行CYP2C19基因多態(tài)性檢測,術(shù)后常規(guī)雙聯(lián)抗血小板治療。CYP2C19基因多態(tài)性檢測提示檢查結(jié)果呈氯吡格雷中間代謝類型,則采用隨機(jī)表法隨機(jī)抽取患者分為繼續(xù)常規(guī)雙聯(lián)抗血小板藥物治療(A組)和改用替格瑞洛90mg每日兩次+阿司匹林100mg每日一次口服治療(B組)。對上述患者進(jìn)行血小板聚集功能監(jiān)測并在患者出院后3個(gè)月進(jìn)行電話、門診或住院隨訪。統(tǒng)計(jì)分析A、B兩組血小板聚集功能及記錄MACE事件。結(jié)果對各組血小板最大聚集率進(jìn)行比較,結(jié)果顯示,A、B組血小板最大聚集率差異具有統(tǒng)計(jì)學(xué)意義。B組血小板聚集率較低,提示替格瑞洛對中代謝患者血小板抑制效果更明顯。對冠心病術(shù)后3個(gè)月MACE隨訪進(jìn)行比較,結(jié)果提示組間無統(tǒng)計(jì)學(xué)差異,替格瑞洛和氯吡格雷在氯吡格雷中間代謝類型冠心病患者術(shù)后近期效果存在一致性。結(jié)論替格瑞洛對中代謝患者血小板抑制效果更明顯;氯吡格雷中代謝患者口服替格瑞洛未能帶來更多的近期臨床獲益。
[Abstract]:Objective: antiplatelet therapy is the cornerstone of coronary heart disease treatment. Clopidogrel is one of the most important antiplatelet drugs. The study found that 41% of patients had clopidogrel resistance, and there were many reasons for clopidogrel resistance. Clopidogrel resistance has been linked to clopidogrel metabolic gene polymorphisms in the body [1], so the U.S. Food and Drug Administration recommends that doctors test CYP2C19 before antiplatelet therapy. To understand the metabolic capacity of clopidogrel, Other antiplatelet drugs, such as tigrilol and Pragray, may be chosen for those with weak clopidogrel metabolism. In view of the fact that Pragray has not yet been officially listed in China and tigrillo is not covered by medical insurance and the cost is relatively high, clopidogrel is still the preferred P2Y12 receptor inhibitor in clinical practice. There is a broad consensus that clopidogrel gene testing suggests that patients with slow metabolism should switch to tigrilol, but it is worth discussing whether the patients with middle metabolism should switch to tigrilol. This study was to investigate the effect of tigrilol on patients with clopidogrel intermediate metabolic type coronary heart disease after PCI. Methods: 97 patients with coronary heart disease treated in Department of Cardiology, Dalian Medical University from December 2015 to September 2016 were studied. All patients diagnosed as coronary heart disease and treated with PCI were treated with Aspirin 300 mg / L OOmg QD, clopidogrel 300mg / 75mg QD), and CYP2C19 gene polymorphism was detected. The detection of the polymorphism of CYP2C19 gene showed that clopidogrel intermediate metabolism type was detected after conventional antiplatelet therapy. The patients were randomly divided into two groups: group A (treated with conventional antiplatelet drugs) and group B (treated with tigrilol 90mg twice a day, aspirin 100mg, once a day). The platelet aggregation function was monitored and followed up by telephone, outpatient or inpatient 3 months after discharge. Platelet aggregation function and Mace events were statistically analyzed in group A and B. Results the maximum platelet aggregation rate of each group was compared. The results showed that the difference of platelet maximum aggregation rate in Agna B group was statistically significant. The platelet aggregation rate in group B was lower than that in group B. it suggested that tigrilol was more effective in inhibiting platelet in patients with middle metabolism. The results showed that there was no statistical difference between the two groups. Tigrilol and clopidogrel had the same effect in the patients with clopidogrel intermediate metabolic type of coronary heart disease. Conclusion tigrilol is more effective than clopidogrel in inhibiting platelet in patients with middle metabolism, and tigrilol does not bring more clinical benefits in the near future.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4
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本文編號：2001710